The Care Quality Commission (CQC) warned that children’s oral health inequalities persisted across England, with five-year-olds in the most deprived areas experiencing more than twice the prevalence of tooth decay seen in the least deprived.
Its State of Care 2025/26 report drew together evidence of unequal disease levels, hospital treatment and access to dentistry, despite a recovery in National Health Service (NHS) activity.
Citing the national oral health survey of five-year-olds, the regulator reported decay among 32% of children in the most deprived areas, compared with 14% in the least deprived.
The CQC reported that, across integrated care board (ICB) areas, prevalence ranged from 12% to 33%. Nationally, around 22% of five-year-olds had visible signs of decay, while 3.7% had advanced decay and 1.8% showed signs of severe dental infection.
The CQC said deprivation remained strongly associated with higher levels of dental disease.
Baroness Julia Neuberger, CQC chair, said: ‘Improvements aren’t keeping pace with demand everywhere, and where they fall short, it’s often the same people and places bearing the consequences.’
Unequal burden of extractions
The report also highlighted differences in decay-related tooth extractions, with rates of 403 per 100,000 children and young people in the most deprived areas, compared with 121 in the least deprived.
Recorded extractions increased from 31,165 in 2022/23 to 33,976 in 2024/25, a rise of 9%. The CQC said preventable oral disease remained a major contributor to hospital activity among children and young people.
These findings reflected previously collected national data, brought together in the regulator’s assessment of care across England.
Recovery in activity, uneven access
The CQC found that NHS dental activity continued to recover, with 37.6 million courses of treatment delivered in 2025/26, up from 35.4 million the previous year. This remained below the 38.8 million delivered in 2019/20.
According to the CQC, nearly 7.2 million children were seen within the previous 12 months, representing 60% of England’s child population. Access varied between ICB areas.
The regulator also found uneven provision of registered dental locations, with lower densities in several rural or mixed rural areas. It warned that this disparity could produce further inequalities in access and oral health outcomes.
‘To repair a fracturing system, there must be a collective response,’ Neuberger said. ‘Providers, regulators, commissioners and government all have a role to play in improving care, and we’ll be judged not by what we achieve alone, but by what we achieve together.’
The report noted examples of practices attempting to boost access for patients. One included example was of a practice opening on Saturdays for a month so working parents could register children for NHS treatment. The scheme proved popular and was extended for another month.
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